Nitroglycerin Patches Do Not Improve Stroke Outcomes

Transdermal delivery of nitroglycerin to lower blood pressure in suspected stroke patients does not lessen post-stroke disability, according to a new study.

Researchers at the University of Nottingham (Nottingham; United Kingdom) conducted a multicenter prospective randomized trial to investigate whether it is safe and effective for paramedics to administer nitroglycerin. The study included 1,149 patients (average age 73, 52% male) with presumed stroke and systolic blood pressure above 120 mm Hg, who were randomized to receive either a nitroglycerin patch or a sham patch in the ambulance within four hours of symptom onset. The primary outcome was a shift in disability measured at three months.

The results revealed that at 90 days, there was no difference among the overall trial population, with an average of 3 points on the 7-point scale modified Rankin Scale (mRS) in both those who got the patch and those who got sham dressings, even among those with a final diagnosis of stroke or transient ischemic stroke. Secondary outcomes revealed that the intervention was worse in patients with intracerebral hemorrhage, and those enrolled within an hour of symptom onset. The study was presented at the annual International Stroke Conference, held during January 2019 in Honolulu (HW, USA).

“More than half had been diagnosed with high blood pressure, 24% had a previous stroke, while 20% had diabetes or atrial fibrillation; the primary outcome was a shift in disability measured at three months. However, nitroglycerin did not improve overall outcome,” said lead author Professor Philip Bath, DSc, of the University of Nottingham. “In patients with a brain bleed, the patch appeared to worsen outcomes. So, treatment with nitroglycerin cannot be recommended very early after stroke.”

Nitroglycerin (1,2,3-trinitroxypropane), is a dense, colorless, oily, explosive liquid which for over 130 years has been used as a potent vasodilator to treat various heart conditions, such as angina pectoris and chronic heart failure (CHF). The beneficial effects are due to nitroglycerin being converted to nitric oxide (NO), a potent venous dilator. Nitroglycerin is available in sublingual tablets, sprays, and patches.

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